Physostigmine salicylate U.S.P.

Physostigmine (Antilirium)

Category:

Nervous system

Description:

Cholinergic, antiglaucoma agent, miotic

Indications:

Wide-angle glaucoma (ophth)
Treatment of anticholinergic toxicity (systemic, including tricyclic antidepressants)

Contraindications:

Inflammatory disease of iris or ciliary body, newborn, organophosphate poisoning
Intestinal or urogenital tract obstruction, asthma, diabetes mellitis, patients receiving choline esters or neuromuscular blocking agents (decamethonium, succinylcholine)

Precautions:

Pregnancy category C
Epilepsy, parkinsonism
Bradycardia, bronchitis, cardiovascular disease

Adverse Reactions (Side Effects):

CNS: anxiety, delirium, disorientation, hallucinations, headache, hyperactivity, seizures
CV: bradycardia, hypertension, hypotension, irregular pulse
EENT: blurred vision, conjunctivitis, decreased secretions in pharynx, lacrimation
GI: abdominal cramps, diarrhea, nausea, vomiting
RESP: bronchospasm, decreased bronchial secretions, dyspnea, pulmonary edema
MISC: hyperpyrexia

Dosage:

Administered intravenously, intramuscularly, topically (ophth)

Adult:
- Glaucoma:
  - Instill ointment Ľ inch strip of 0.25% ointment in conjunctival sac 1-3 times daily
  - Instill solution 1 drop of a 0.25%-0.5% solution in conjunctival sac 1-4 times daily
- Anticholinergic toxicity:
  - IM/IV 0.5-2mg given at a rate not greater than 1 mg/min; repeat every 20-30 minutes; max single dose 4mg, as needed
Child:
- Glaucoma:
  - See adult
- Anticholinergic toxicity:
  - IV 0.2mg (20 mcg)/kg over at least 1 minute; may repeat every 5-10 minutes; max dose 2mg

Source: Operational Medicine 2001, Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300